Treatment for Pornography: From Disease Model to a Response by Men

Treatment for Pornography Addiction often focusses on the act of watching pornography and assistance to try to reduce the ‘behaviour’. But if such an approach doesn’t work, what are the alternatives and why don’t we hear more about them?

I’ve been working with concerns about addiction to pornography for a number of years now. When men started to contact me seeking help (and it was mostly, although not always, men who wanted help with porn use) many of them came to me equipped with a glossary of terms from 12-Step programmes like SAA (Sex Addicts Anonymous), SLAA (Sex and Love Addicts Anonymous), SCA (Sexual Compulsives Anonymous) and SA (Sexaholics Anonymous). They spoke of concepts like ‘sobriety’, ‘healthy sexuality‘ and ‘bottom-line behaviours’.

Alternative Treatment to 12 Step Programmes

Some of these men had invested quite a lot of time reading about these models of addiction, understanding the group concepts and attending groups. At the same time, they were consulting me because the groups and 12-step programmes had not completely worked for them: they were still using pornography or were dissatisfied with the amount or type of pornography that they were viewing. Ironically, most of the men who had turned to the 12-step model seemed to want to continue to use the terms and concepts the programme had taught them, despite deciding it hadn’t worked.

It is not always possible to continue to view our actions through the same lenses to which we are accustomed, particularly when those lenses fail to provide us with clarity or vision. One of the difficulties of trying to develop what I call ‘self-agency’ when working within a 12-step model is that the model itself tells the person he is powerless. So it is kind of at odds with the idea of gaining more influence over one’s own life and actions.

The ‘brain chemistry’ model supports a sense of powerlessness as well. If we don’t understand the chemistry of the brain – and perhaps even if we do – we are at its mercy. But dialogue can create meaning. Do we really need to pretend pornography use is all about complex science only specialist medical doctors understand?

Brain Chemistry or Sobriety? Both are Disease Models of Porn Addiction

Both of these approaches assume that pornography use is a disease. And many people are surprised to find out that there is no diagnosis of pornography addiction according to the major disease classifications, I realised quite early on that simply accepting that addiction to pornography was a disease would spin off a number of assumptions about a person’s use of pornography that might go unquestioned. So instead of looking at what was the same for these men who were consulting me, I started exploring what might be different for them. And I found many differences. In fact, every man who contacted me had a unique story. While there were some common threads, failing to approach their stories as unique narratives of porn use clearly meant I was missing crucial details about what was significant in each man’s history and the way porn had found its way into his life.

I believe it is disrespectful and fundamentally flawed to use a ‘colour-by-numbers’ approach to concerns about porn use. We need to look beyond the act of a man looking at pornography and instead consider the ways in which that act might be a response. And to what it might be a response. Focusing on porn use as a problem rather than as a response is like simply focussing on cars as the cause of traffic accidents without ever considering transport needs. People watch porn for many different reasons. What I offer is a chance to explore those reasons and investigate how pornography has taken such a place in a man’s life.

But there is another point to be made here. It’s not my place to judge a person’s porn use. The medical model suggests we give ourselves up to the doctor or psychotherapist who presumably knows best. The risk is that the patient or client becomes more or less a helpless victim. When men contact me, I’m interested in their concerns and why they are finding their porn use a problem. I don’t start with an agenda that I know best. So these therapeutic meetings are dialogical: they happen through conversation. They aren’t about instructing men what to do or passing judgement on their actions. Instead we explore the topic brought to the session and develop meaning around it together, in dialogue. That is the way to new understanding and more influence over the choices made in life.

About Forward Therapy

Ash Rehn is a counsellor and narrative therapist with over 20 years experience. He specialises in therapeutic conversations and collaborative therapy for anxiety, burnout, depression, midlife crisis, sex and relationship issues, pornography use problems and counselling for lesbians and gay men.